乙型肝炎相关慢加急性肝衰竭死因与HBV抗原变异相关性探讨.docVIP

乙型肝炎相关慢加急性肝衰竭死因与HBV抗原变异相关性的探讨 　　[摘要] 目的 分析乙型肝炎相关慢加急性肝衰竭（HBV-ACLF）的死因，探讨其与HBV病毒抗原变异之间关系。方法 收集HBV-ACLF患者，分为存活组与死亡组，分析其死因及BCP区、C区及前C区突变率构成比，通过非条件多因素Logistic回归分析各突变位点与HBV-ACLF患者死亡的相关性，比较MELD及Child-Pugh评分标准。结果 HBV-ACLF患者127例，其中存活组76例，死亡组51例，检测到突变位点329个，多因素Logistic回归分析结果显示，两组间A1762T/G1764A、G1896A、L60V差异有统计学意义（P0.05），两组患者MELD评分差异有统计学意义（P0.05）。 结论 在HBV-ACLF患者中A1762T/G1764A、G1896A、L60V等基因位点突变是导致其死亡的独立危险因素，而且MELD评分优于Child-Pugh评分，MELD评分对于判断HBV-ACLF的预后及转归有重要意义。 　　[关键词] 慢加急性肝衰竭；乙型肝炎；抗原变异；生存分析 　　[中图分类号] R575.3 [文献标识码] A [文章编号] 1673-9701（2015）35-0008-03 　　[Abstract] Objective To investigate the relationship between HBV antigen variationandthe cause of deathin the HBV-related acute-on-chronic liver failure （ACLF）. Methods Total of 127 HBV-ACLF patients were divided into survival group and death group， the cause of death， the constitution ratio of mutant rate pre-C region， C gene region and BCP region of two groups were analyzed than before， then MELD and Child-Pugh score system were compared through multivariate Logistic regression analysis to discuss the risk degree of different mutants. Results In 127 cases of HBV-ACLF patients， 329 mutants were detected between the survival group（n=76） and the death group（n=51）. The differences of A1762T/G1764A， G1896A and L60V were significant in the death group than in the survival group according to the results of multivariate Logistic regression analysis（P0.05）， and the scores of MELD were significant difference than the scores of Child-Pugh in the two groups（P0.05）. Conclusion The mutants of A1762T/G1764A， G1896A and L60V in HBV-ACLF are independent risk factors lead to its death， MELD score over matches Child-Pugh score，and MELD score for judging the prognosis and outcome of HBV-ACLF has important significance. 　　[Key words] ACLF； HBV； Antigen variation； Survival analysis 　　乙型肝炎相关慢加急性肝衰竭（HBV-related acute-on-chronic liver failure，HBV-ACLF），又称慢性重型肝炎，是指在慢性肝病病理损害的基础上发生新的程度不等的肝细胞坏死性病变，短期内发生急性肝功能失代偿为主要临床表现。HBV-ACLF是我国肝衰竭中最常见的类型，占80%～90%[